Health reform passes — and launches new political battles by Minnesota lawmakers

House Majority Leader Steny Hoyer and Speaker of the House Nancy Pelosi celebrate healthcare bill passage after vote on Capitol Hill on Sunday.
REUTERS/Larry Downing
House Majority Leader Steny Hoyer and Speaker Nancy Pelosi celebrate health-care bill passage after the vote on Capitol Hill Sunday.

WASHINGTON — Cheers erupted on the House floor Sunday night as the vote count hit 216, the magic number of representatives needed to pass the Senate’s health care reform bill through the House. Later this week, President Obama will sign into law the largest single reform of the nation’s health care system since the creation of Medicare in 1965.

The final tally was 219 in favor to 212 against, with all Republicans present voting no. As expected, Democrats Keith Ellison, Betty McCollum, Jim Oberstar and Tim Walz voted for the bill, while Democrat Collin Peterson joined Republicans John Kline, Michele Bachmann and Erik Paulsen in opposing it. About an hour later, the House passed a reconciliation bill including “fixes” to the just-passed health care legislation with one additional yes vote.

“This isn’t radical reform, but it is major reform,” President Obama said. “This legislation will not fix everything that ails our health care system. But it moves us decisively in the right direction. This is what change looks like.”

Advocates agreed with Obama that the bill isn’t perfect. Ellison and McCollum wanted a public option (they still haven’t given up on that), while Oberstar and Walz held out until almost the bitter end in an effort to remedy geographic disparities in Medicare rates.

Rep. Jim Oberstar
Rep. Jim Oberstar

“Health care’s always an evolutionary process, and we’ll have to continue to make adjustments, but tonight is a benchmark, landmark, watershed achievement,” Oberstar said.

“Tonight’s enormous,” Ellison agreed. “It’s up there with the civil rights bill, it’s up there with Medicare, it’s up there with Social Security. It will be part of the economic/social/political framework of America within five years — it will be how we live.”

A reconciliation bill containing “fixes” to the approved health care bill now heads to the Senate, where Republicans said they plan to raise a host of procedural objections to the bill’s applicability under budget reconciliation rules. Meanwhile in the House, Kline and Bachmann pledged to fight to repeal the legislation starting as soon as it’s signed.

“Today’s votes were a loss for the American people, but the battle is far from over,” Kline said in a statement following the vote. “We must now begin working to undo the government takeover of health care and replace it with meaningful reforms that will finally bring down health care costs.”

Jockeying for votes
Until the final days, Democrats weren’t entirely sure they had Oberstar and Walz on board. Both had said they were leaning yes, but held out over Medicare rates (Oberstar’s spokesman admitted as much, comparing his boss’ stance to a poker player who knows when to hold ’em). They decided on Saturday to finally commit, but the story of how they became “Yes” votes actually starts about nine months ago, in June of 2009.

House Speaker Nancy Pelosi was leaving a Democratic caucus meeting just as McCollum rose to speak about an issue she said was costing Minnesota hospitals millions — the geography-based Medicare reimbursement formula that pays medical providers in Texas, California and South Florida sometimes twice as much for the same procedures as high-quality providers like the Mayo Clinic in Rochester, despite Mayo having better patient outcomes.

Rep. Betty McCollum
Rep. Betty McCollum

Pelosi stopped and listened. When McCollum finished, and a number of other Midwestern lawmakers finished agreeing with her, Pelosi committed to addressing the Medicare formula in this health care legislation. Soon after, the Congressional Quality Care Coalition was formed.

At 3 a.m. Saturday, that same coalition would come to an agreement with the White House and lawmakers from high-cost states like Texas, California and New York on geographic disparity, including $800 million over the next three years for doctor and hospital payments in states including Minnesota. A conference on geographic disparity will be held later this year, in anticipation of the formula being rejiggered by 2012. By 2014, a quality-of-care metric will be added, paying providers more for achieving better patient outcomes at a lower cost.

“People have been trying to do that for decades,” McCollum said, triumphant. Shortly after that deal was announced Saturday, Walz and Oberstar announced their support.

None of the Republicans were really gettable, Democrats said, and neither was Peterson. Asked if she had lobbied Peterson to flip his no vote to a yes, McCollum replied “Nope, Collin made it pretty clear a while ago that he was not going to vote for health reform.”

“Collin’s a very strong-willed person,” Ellison agreed. “I don’t think it would be much use of my time to try and get him to do something he doesn’t want to do. I don’t even bring it up with him, because I guarantee you he has nine reasons he can cite at the drop of a hat why he’s not doing it, so he’s not doing it, and that’s why I’m glad we have 216 votes to do it.”

Rep. Collin Peterson
Rep. Collin Peterson

Peterson issued a statement following the vote citing his reasons why he opposed the measure. “In my judgment, while these bills deliver some good things they miss the mark on the most important things and will not deliver as promised,” he said, saying the bill doesn’t cut health care costs and would only cover 37 percent of the uninsured in the 7th District.

“This legislation avoided making the critical reforms we really need in order to strengthen our rural health care system and by doing so it punts these problems into the future where it’s likely that they’ll be even more difficult and more expensive to solve.”

Next up
Senate leaders say they have at least 52 votes to pass the reconciliation package, and most tallies included Amy Klobuchar and Al Franken among the likely yeses. Consideration of the bill will begin likely Wednesday, with the goal of voting before the week ends.

Should the reconciliation measure pass the legion of parliamentary challenges it’ll face, it will go to the president for his signature before Easter.

Ellison said he still plans to raise the public option in an effort to get that passed. “Once we’ve got started, why stop?” he asked.

Rep. Keith Ellison
REUTERS/Eric Miller
Rep. Keith Ellison

If the goal is to do that this year, someone in the Senate will likely have to tack it on to the reconciliation bill the House just passed, as one can only do one reconciliation bill each budget year. While there are more than 40 votes in the Senate for a public option, it’s unlikely that anything will be added to the bill for fear of having to re-pass it in the House. Indeed, fears of adding anything and upsetting the proverbial apple cart prompted the House Rules Committee to reject every single amendment brought to it for inclusion in the health care package voted on Sunday night.

One of those rejected amendments was a Paulsen measure that would have removed a $20 billion (over 10 years) fee on medical devices, saying the levy is likely to result in manufacturers who are currently based in his 3rd District packing up shop and heading to other countries where they don’t face that tax burden.

Paulsen said he’ll keep working on that, but expects the House to pivot to other issues, including financial reform and the deficit.

“I think we’re going to move on to a number of other issues this year, but clearly it seems like the most defining issues center around the levels of spending and borrowing and national debt,” Paulsen said. “I don’t think people are going to forget this vote, they’re not going to forget the budget votes they’re going to be paying attention to Washington living within its means which we’re not doing.”

Elections coming
Outside the House chamber is the Speaker’s Lobby, an ornate room of portraits and chandeliers where members used to take their smoke breaks. Now that smoking is forbidden, members are forced to use a balcony just off the lobby. In front of that balcony Sunday was a crowd of a few-hundred Tea Party protesters who cheered as Republicans emerged and booed as Democrats came out for fresh air.

Bachmann and Kline took many trips to the balcony today, each taking their turn clapping, cheering and pumping their fists. That riled up the crowd, which responded with chants of “Kill the Bill!” and “USA, USA, USA!” That was perhaps a bit nicer than the pitch-perfect “Na na na na, na na na na, hey hey hey, goodbye” that many Democrats got.

Rep. Michele Bachmann
MinnPost/Raoul Benavides
Rep. Michele Bachmann

Those Tea Partiers were clearly thinking election — indeed it’s impossible to think about a controversial piece of legislation in an election year without thinking of the upcoming midterms. Minnesota doesn’t have any truly toss-up districts this fall, but it does have two incumbents that opposite party strategists are set on ousting.

For Democrats, that’s Bachmann. For Republicans, it’s Walz. And make no mistake; this vote will be used time and time again against each of them.

Americans United for Change will announce at 9 a.m. Central that they’re going up with a $100,000 TV ad buy hitting Bachmann for her vote.

“Just like Social Security or Medicare or civil rights, those like Congresswoman Bachmann who voted to protect the status quo will find themselves on the wrong side of history,” said Tom McMahon, acting director of Americans United for Change. “Michele Bachmann made a different kind of history by voting to deny giving Minnesotans access to the same kind of insurance she enjoys very much as members of Congress. If it’s good enough for her, shouldn’t it be good enough for the people of Minnesota?”

Bachmann said the “people will decide” who they reward for whatever votes they’ve cast, but predicted surprisingly “big, big losses” for Democrats this fall.

The Democrat with the biggest target on his back is Walz. State GOP chairman Tony Sutton issued a statement calling Sunday night’s House vote an “historic disaster,” saying Walz “will lose his seat for his decision to ram this deeply unpopular and partisan bill down the throats of the American people.”

Tom Erickson, spokesman for the National Republican Congressional Committee, echoed those words, saying, “Walz can expect that the upcoming campaign will be the fight of his life.”

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Comments (14)

  1. Submitted by Thomas Swift on 03/22/2010 - 09:59 am.

    The Democrat congress has just made it a *crime* not to buy the products insurance companies make available.

    That’s right, Mr. and Mrs. America…you, yes you are now mandated by federal law to contact your friendly broker and get yourselves “insuranced up”.

    Oh, and by the way; there is nothing in the ObamaCare bill that forces, or entices insurance companies to lower their costs, or even prohibits, in any way, the raising of your premiums. Just be quiet and send it in folks…it’s the law, and you don’t want any trouble, do you?

    Best of all, and I know you’ll all love this, the Democrat mandatory insurance law makes the IRS the enforcement division of Anycompany Insurance, Inc…boy I bet the CEO of Blue Cross-Blue Shield is really singing the blues today.

    Congratulations Democrats; you really showed ’em!

  2. Submitted by Richard Schulze on 03/22/2010 - 10:13 am.

    For now, the significance of the vote is moving the United States FROM a system in which people can assume they will have health coverage IF they are old enough (Medicare), poor enough (Medicaid), fortunate enough (working for an employer that offers coverage, or able themselves to bear expenses), or in some other way specially positioned (veterans; elected officials)… TOWARD a system in which people can assume they will have health-care coverage. Period.

  3. Submitted by dan buechler on 03/22/2010 - 10:37 am.

    Thomas, 3.47 billion was spent to defeat this bill. Thanks for stimulating the economy. YOU LOST. Now journalists can someday connect institutional power and money to politics. THIS IS A GREAT DAY (coming from one who was discriminated against because of his age of 52)

  4. Submitted by Bill Kellett on 03/22/2010 - 10:46 am.

    Tom
    Is this like that outrageous Minnesota law that requires me to buy automobile insurance from private companies? I’ll bet the president of Allstate has been grinning for years. Damn socialists.

  5. Submitted by Paul Brandon on 03/22/2010 - 11:18 am.

    There’s a basic difference between Bachmann and Walz:
    Bachmann is on the extreme right wing of her party, and was re-elected on a relatively narrow vote despite being in a district that votes very strongly Republican.

    Walz on the other hand is a very moderate Democrat (sometimes to my frustration) who represents his district very well, concentrating on issues like veteran’s affairs and agriculture which are thoroughly nonpartisan.
    He has a reputation of taking care of his own (constituents) rather than his own (ideological bedmates).
    And contrary to some comments, the First District is not a sure Republican stronghold; Tim Penny also was elected (and re-elected) as a middle-of-the-road Democrat very much like Tim Walz (maybe it’s something about the first name ;-).

  6. Submitted by Thomas Swift on 03/22/2010 - 12:02 pm.

    It’s funny you mention the mandatory auto coverage laws, Bill. The implementation will indeed be similar, but the premise is not quite the same.

    You see, Bill, a logical consideration of the issue concludes that if you don’t need to own a car, you don’t buy insurance; won’t work quite the same with your body.

    Still, your point is well taken. Allstate has been enjoying the benefits of government mandated and enforced marketing for years; I guess it’s only fair Blue Cross/Blue Shield gets its lotto win too….

    dan, you’re right *we* lost…*your* victory party, however, must wait while we all trot out for our appointment at BigMed Insurance, Inc. (please stand behind the yellow line until your number is called); procrastination could lead to an IRS garnishment.

    Insurance up; It’s the law.

  7. Submitted by John Roach on 03/22/2010 - 12:22 pm.

    I always enjoy Mr. Swift’s hyperbole. Using his reasoning, it is also a “crime ” to rent rather than make a mortgage payment. The tax paid on what would otherwise be mortgage interest is the “penalty”. And it is even enforced by the same jackbooted IRS thugs that will collect the health care “fines”!

    Perhaps Mr. Swift should consider joining Rush Limbaugh, who has announced his intention to flee the oppression of accessible health care by moving to Costa Rica. Before he makes his decision though, I should point out that Costa Rica suffers under the tyrannical yoke of universal, national health care.

  8. Submitted by Bill Coleman on 03/22/2010 - 01:09 pm.

    I chuckle at the GOP that now wants to block the reconciliation process. Knowing only a bit about what will be in that bill the Nebraska bribe, the tax on luxury health care insurance, etc., I cannot imagine how they will stand up and oppose this process. You have to give them credit for stirring outrage against a package of reforms that contains individual items that the vast majority of people are for.

    I wonder what the health care demographics are for those who are so vehemently opposed. Are they people with health insurance who are afraid that they will have to pay more? Are they people who choose not to have health insurance who will have to purchase it? Are they people who own companies with more than 50 employees that do not now offer insurance that will now have to do so or pay fines?

    Thomas Swift, why didn’t the GOP had done anything on health care when they had the chance. I do not remember a Democratic filibuster on tort reform, selling insurance across state lines and enabling small businesses to create cooperatives to do joint purchasing of insurance. If that was all it took to fix health care, why didn’t your party do this? And if you are going to force insurance companies to cover pre-existing insurance but not require it, why would anyone buy it before they needed it?

  9. Submitted by Paul Brandon on 03/22/2010 - 01:26 pm.

    From Paul Krugman (who actually understands economics):

    “The Market Yawns

    Andrew Leonard has a good point: if Obamacare is such a disaster for the economy, where’s the market reaction?

    More broadly: the perceived probability of passage, as indicated by Intrade, was only around 30 percent a month ago (which is why I’m still rubbing my eyes). So the expectations of what we’re told would be a great disaster have risen dramatically. And the market has yawned.

  10. Submitted by James Hamilton on 03/22/2010 - 02:06 pm.

    “This isn’t radical reform, but it is major reform,” President Obama said. “This legislation will not fix everything that ails our health care system. But it moves us decisively in the right direction. This is what change looks like.”

    Yes, it is radical reform, Mr. President, and no, it does not fix everything that is wrong with health care and health insurance in the U.S. It likely will cause new problems in many ways. We need to be alert for these and be prepared to fix them when they arise.

    I’m saddened by the idea that McCollum and Ellison (among others, no doubt) feel it necessary to immediately begin a push for a public option. The public option has always been the most controversial and heavily opposed idea presented in health care reform. It will continue to be, but need not be. Some are convinced (before the effort is made) that a federally regulated health insurance industry cannot provide universal coverage affordably. While there may be reason to be cynical, given the health insurance industry’s history, we’ve never before had a uniform body of regulations in this country. It works elsewhere and can work here.

  11. Submitted by Greg Kapphahn on 03/22/2010 - 02:24 pm.

    The difference between Walz and Bachmann is that Walz is a big man, in the best sense of the world, but Bachmann is nothing but a big mouth.

    This is an historic event. I’m glad I was around to see it finally happen. The more the conservative reichwingnuts (who cheered as the Rebs. spent the Bushco presidency doing nothing for the American public while writing government checks and tax cut bills for each other and digging most of the financial hole the nation is in at this point)…

    The more they whine and moan (T.S.?) the more I’m convinced that this bill, these reforms, and these days are something to remember and celebrate.

  12. Submitted by chuck holtman on 03/22/2010 - 02:38 pm.

    Mr. Hamilton: I have googled to refresh my memory, and find, as was my recollection, that a large number of polls by “mainstream” polling firms/media over a period of months found the public option, in essentially every poll, to be favored by 60 to 80 percent of respondents. When you say that it has been the “most controversial and heavily opposed idea,” what do you mean?

  13. Submitted by Bernice Vetsch on 03/22/2010 - 04:11 pm.

    James Hamilton (#9) — “…a federally regulated health insurance industry cannot provide universal coverge affordably.”

    Sorry, Mr. Hamilton, but the countries with heavily regulated insurance industries provide 100 percent universality while spending half as much on health care as we do.

    Norway, Switzerland and others consider health insurance a public utility and regulate their prices as we regulate those of the Excel Energy. All insurers are private-sector nonprofits; all must honor every claim and insure every person who applies. The government develops a benefit set and drug formulary common to all citizens and insurers, reviewing medical costs yearly to see if premium costs should be raised.

    The insurers in those countries compete on the basis of customer service. Refreshing, no? They all make a living, but are not allowed to make obscene profits by denying the product their customers have paid for.

    All—FOR AN ANALYSIS OF THE NEW BILL from the viewpoint of single-payer advocates Physicians for a National Health Plan, see their March 22 press release at http://www.commondreams.org. They note the bill’s weaknesses and preferential treatment of corporations and remind us all that, by enacting single-payer health care, every person without exception could see his/her doctor whenever necessary. And we would still save $400 billion per year.

  14. Submitted by Richard Schulze on 03/22/2010 - 08:43 pm.

    Mr Swift,
    Under the old system, a lot of healthy younger people decided that premiums had risen so high that it wasn’t worth it for them to buy insurance. They figured they were better off taking their chances. In so doing, they were freeloading off of the rest of society.

    But healthy people who forgo insurance are playing the same game as “too big to fail” financial institutions: they know that ultimately, if they’re hit by a car, the hospital will have to treat them, and if they can’t pay the full cost, the rest of society will, through higher treatment costs and insurance premiums. They’re drawing the emergency-care benefits of the American health system, but they haven’t paid their dues.

    The new law fixes this by mandating that everyone buy insurance. So it will no longer be possible for healthy people with adequate incomes to decide they’d rather spend that money on a nicer car, and let the rest of us pay for their care when they fall ill.

    I would think that this is a concept that most conservatives could embrace.

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